Chronic Kidney Disease Prior to Dialysis: The Diet Talk!

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The basic

Your kidneys are one of the most essential and important organs in your body. Its functions are vital to keep you healthy. Their mission is to maintain a stable balance of body chemicals and fluid. The kidneys work to:-

1) Remove drug, toxin and metabolic wastes from your body,

2) Regulate body fluid,

3) Control the acid/base balance in your body.

They are also part of the endocrine system i.e. they activate and produce hormones that can affect the functions of other body organs. For example, they secrete the hormone renin, to regulate blood pressure and erythropoietin to stimulate the production of red blood cells. They also activate vitamin D for bone metabolism.

The functional unit of your kidneys is called nephron. Nephron works like a cleaner by removing excess body fluid, toxins and wastes from blood and excreting these by-products out of the body in the form of urine. If your kidneys are not functioning well, this excretory process will be affected. All those waste products will start building up in your body and if this condition left uncontrolled and untreated, it will eventually jeopardise your health.

Managing Diet: Part of Disease Management

When you are diagnosed with chronic kidney disease, your doctor will usually advise you to keep an eye on your diet. The underlying reason is to reduce the burden of your kidneys and hence slow the disease progression. However you should not under-feed your body either. Under-nutrition and/or underweight will put you at risk of other diseases such as infection. In short, your diet should still remain adequate and healthy.

Here are some major nutrition components that need your attention:-

  • Calories
    Adequate calorie intake is the key of weight maintenance. You should keep your weight in healthy range. Slow and sustainable weight loss is recommended if you are overweight or obese and healthy weight gain is recommended if you are underweight.
  • Protein
    Excessive protein intake increases urea production and your weakened kidneys may not be able to process urea well. Eventually, urea will build up in your body and affect your health. High blood urea levels can cause fatigue, loss of appetite, nausea, vomiting and even skin itchiness. However, adequate protein intake is important for body functions, especially in building, maintaining and repairing body tissues. Hence, for someone with CKD, you should consume protein in adequate amount but not in excess.(Click here to learn how to control protein intake)
  • Sodium, phosphorus, and potassium
    Your kidneys are the main organs that closely regulate these minerals in your body in order to ensure they are stay balanced. However, when your kidneys are not able to function optimally, these minerals start to accumulate in your body. High levels of these minerals in bloodstream can cause a variety of disease complications: high blood sodium can lead to edema and high blood pressure;  high blood phosphate levels can cause bone disorder and coronary heart disease; and  high blood potassium levels relates to irregular heart beat. Hence, you are usually advised to limit intake of these minerals if your blood test result shows abnormality.(Click here to learn how to control sodiumphosphorus, and potassium intake)

Use of dietary supplements

As their name implies, dietary supplements are any consumed products that aim to supplement your diet and meet your nutritional needs. Besides vitamins and minerals, they can contain herbs, amino acids, enzymes, fiber and fatty acids. With your current medical and treatment conditions, use of dietary supplements without the consent of your doctor and/or dietitian can be dangerous and is not advisable. Dietary supplements can have potent pharmacological activity, questionable chemical components, chemical/microbial contamination and effects that interfere with your medications and even harm your kidneys. To play safe, you should ask your healthcare providers if you truly need them. Remember, be skeptical, smart and well-informed before taking any dietary supplements!

Let a dietitian help you out

You could be frustrated, lost and stressful when you know that you need to have dietary changes as part of your disease management and yet you have no idea about how to start and what is the right approach.  For this matter, you can always consult a dietitian. A dietitian is a trained and qualified healthcare professional in the area of food and nutrition. He/she delivers accurate and up-to-date nutrition information and helps you to achieve your nutritional needs based on your disease condition, food preference and lifestyle. So, feel free to share your ‘dietary burden’ with dietitian!


  1. Malaysian Dietitians’ Association. Medical Nutrition Therapy Guidelines for Chronic Kidney Disease, 2005.
  2. Ministry of Health. Clinical Practice Guidelines: Management of Chronic Kidney Disease in Adults, 2011.
  3. Academy of Nutrition and Dietetics- Evidence Analysis Library. Chronic Kidney Disease: Executive Summary of Recommendation, 2010.
  4. National Kidney Foundation. Use Of Herbal Supplements In Chronic Kidney Disease. 2013. [Cited 27th January 2013] Available from